OPHTE# ,3 —a'�1 Harnett County Department of Public Health
PERMIT # �-� �� ® Operation Permit 22861
New Installation X Septic TankX Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 0 ec-s
Name: (owner) C- LC C� r^�-5 SUBDIVISION OP,"( ,N0 l LOT #
System Installer: G -o 0', E Gc--A vcee— Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms
Type of Water Supply: El Community Public ❑ Well Distance from well 1 feet
System Type: ��Ntl Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
PERMIT CONDIIIUNJ:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned pry° erty
Type of system: ❑ Conventional '5�, Other Qua) d Q'kA°%Q01 Septic Tank: M0 gallons Pump Tank: tbOb gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch �) � C) feet ditches 3 feet ditches ) '9°30 inches
French Drain Required: Linear feet
Authorized State Agent 1 �•�t,� —��wr ����
Date co /�p la. 1 3
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